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General NPI Number Information
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NPI Number | 1932753811
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Entity Type | Organization
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Legal Business Name | RESURGENT SPORTS REHAB LLC
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Dates
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Enumeration Date | 07/29/2019
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 8500 EXECUTIVE PARK AVE STE 100
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City | FAIRFAX
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State | VA
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Zip | 22031-2228
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Country | US
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Telephone | 703-346-6517
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Fax |
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Provider Business Mailing Address
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Address Line | 2868 SUTTON OAKS LN
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City | VIENNA
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State | VA
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Zip | 22181-6146
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Country | US
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Telephone | 703-346-6517
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DYANNA GERBER
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Credential |
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Telephone | 703-346-6517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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